Long-term effect of gemcitabine-combined endoscopic ultrasonography-guided brachytherapy in pancreatic cancer.

BACKGROUND AND STUDY AIMS: Iodine 125 radioactive seeds implanted by endoscopic ultrasonography (EUS) represent a novel strategy for the treatment of pancreatic cancer. However, its long-term effects still remain unknown. The aim was to provide reliable data of long-term effects. Moreover, whether chemotherapy affects the result of EUS-guided implantation was also determined.

PATIENTS AND METHODS: The present study prospectively observed 100 cases of unresectable pancreatic cancer underwent EUS-guided interstitial implantation of 125(I) radioactive seeds. Mean age was 60.9 years and 75% patients were staged III or IV. Eighty-five patients received routine gemcitabine-based chemotherapy one week after brachytherapy. The overall survival (OS) and progress-free survival (PFS) rates were evaluated for long-term effects.

RESULTS: The mean follow-up time was 7.80±6.10 months (0.3-36 months), and the estimated median PFS and OS were 4.5 months (95% CI 3.1-5.9) and 7.0 months (95% CI 5.3-8.8), respectively. The estimated one-year and two-year survival rates were 21.0% and 4.0%. VAS scores dropped dramatically after one-week post implantation, and maintained significantly lower until the third month. Noticeably, there was no statistically difference on median survival time between cases with early and advanced cancer (8.6 vs. 6.0 months, p>0.05), nor between cases with or without previous chemotherapy (7.2 vs. 7.0 months, p>0.05). However, cases with post-implantation chemotherapy had a longer median survival as 7.8 months, compared with those untreated (4.0 months, p=0.003).

CONCLUSIONS: Our data suggested EUS-guided radioactive seeds implantation an effective method to relieve pain in pancreatic cancer. However, no affirmative prolonged survival was observed and following chemotherapy was still necessary.